Beating Breast Cancer

Experts say Early Detection Is Still Best Strategy

Lindsay Kottmann

Extended hormone replacement therapy. Obesity combined with excessive drinking. Family history. And being over age 50.

Those are some of the only factors researchers have determined that seem to put women at greater risk for breast cancer. While theories have come and gone over the years, there’s still little known about the disease’s actual cause. There isn’t a lot that women can do — or not do — today to prevent getting breast cancer.

“The more we know about breast cancer, the more we realize we don’t know,” sums up Dr. Kathleen Halvin, a medical oncologist who practices at UC Health.

While there’s still a lot of work to be done, treatment of the disease has come a long way. “It’s nothing like what we had to do 20 years ago,” Havlin says.

Different Tumors, Different Treatments

It’s frustrating for breast cancer doctors when they treat two women who appear to have similar tumors, then observe two completely different results from the treatment. Much of today’s breast cancer research consists of learning to categorize subtypes of tumors and finding out how they react to treatment.

“We’ve gotten smarter at finding out which women benefit from which treatment,” says Dr. Sandra Miller, a breast surgeon affiliated with Christ Hospital. “Ten or 20 years ago, all women would have gotten the same treatment. Today, it’s much more individualized.”

One of the more recent advances in the ways that doctors can get more information on specific tumors has resulted from advances in genetic testing.

After a tumor is removed, Havlin explains, doctors can biopsy it and run a test that determines the likelihood of recurrence on a scale of one to 100 based on the presence of more than 20 genes. From the results of that test, doctors can determine whether the patient has a low, intermediate or high risk of recurrence, and they can make recommendations for chemotherapy accordingly.

“That’s been the thing that’s changed our practice the most in the last five years,” Havlin says.

Also, genetic research has enabled doctors to test for certain mutations that denote increased risk for developing bilateral breast cancer and ovarian cancer. Doctors don’t usually run this test unless there is a family history of breast cancer, or family history is inconclusive enough to warrant a check.

“Having the gene doesn’t really determine how they’re going to do with their cancer; it just places them at increased risk,” Havlin explains.

If you do have the gene, treatments can range from more frequent screenings, Magnetic Resonance Imagings (commonly referred to as MRIs) on the breast, or hormone blocking medication to reduce the risk of developing cancer.

“Some of those women opt to have their breasts removed and reconstructed and their ovaries removed, as well,” Miller says.

However, only an estimated five to 10 percent of breast cancer patients have the genes (doctors currently can only test for two: BRCA1 and BRCA2) that indicate an increased risk.

No Such Thing as “Low Risk”

Miller points out that such advancements in genetic testing may mislead women to believe that if they don’t have a family history of breast cancer, they don’t have to worry about getting it. In fact, she says, many of the women she diagnoses say they never thought they’d get breast cancer because it didn’t run in their family.

“When it comes to breast cancer in genes, although there are a few women we can identify as high risk, we can’t identify low risk,” she says. “Screening is important for all women.” Doctors emphasize that catching the tumor while it’s still small and hasn’t spread to the lymph nodes — the first stage of cancer — is the best way to improve the outcome.

“People need to know that it can be a very curable disease when caught early,” Havlin says. However, it can be successfully treated at later stages, as well, depending on the characteristics of the tumor.

Know the Facts

Regular mammograms are essential to early detection, doctors emphasize, but some women still hesitate to get them. “They’re uncomfortable for a minute or less, but they don’t really hurt,” Havlin says. The only exception is that pre-menopausal women may have a degree of tenderness if they’re at a certain stage of their menstrual cycle.

Women also may be intimidated by getting tested for breast cancer because they think the treatment involves removing the breasts, Miller says. However, there are many other treatment options available, and bigger is not necessarily better when it comes to surgery.

“A lot of women can be just as well treated with a lumpectomy as getting their breast removed,” she says.

Another misconception concerns the debilitating effects of chemotherapy, usually from word-of-mouth horror stories from relatives or friends. In reality, many women can tolerate chemotherapy quite well because of the advancements in what Havlin refers to as “supportive care” — things such as anti-nausea medication. However, she adds, the two mostly unavoidable symptoms of chemotherapy are hair loss and fatigue.

“I have many patients who have chemotherapy and work full-time,” Havlin says. They’re tired, of course, but they usually are able to maintain a normal routine with more sleep than usual.

Common Breast Cancer Terms

Clinical Breast ExamYour healthcare provider feels each breast for lumps and looks for other problems. If you have a lump, your doctor will feel its size, shape and texture. Your doctor will also check to see if it moves easily. Lumps that are soft, smooth, round and movable are likely to be benign. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer.

Diagnostic Mammogram
Diagnostic mammograms are X-ray pictures of the breast. They take clearer, more detailed images of areas that look abnormal on a screening mammogram. Doctors use them to learn more about unusual breast changes, such as a lump, pain, thickening, nipple discharge, or change in breast size or shape. Diagnostic mammograms may focus on a specific area of the breast. They may involve special techniques and more views than screening mammograms.

Ultrasound
An ultrasound device sends out sound waves that people cannot hear. The waves bounce off tissues. A computer uses the echoes to create a picture. Your doctor can view these pictures on a monitor. The pictures may show whether a lump is solid or filled with fluid. A cyst is a fluid-filled sac. Cysts are not cancer. But a solid mass may be cancer. After the test, your doctor can store the pictures on video or print them out. This exam may be used along with a mammogram.

Magnetic Resonance Imaging
MRI uses a powerful magnet linked to a computer and makes detailed pictures of breast tissue. Your doctor can view these pictures on a monitor or print them on film. MRI may be used along with a mammogram.

Biopsy
Your doctor may refer you to a surgeon or breast disease specialist for a biopsy. Fluid or tissue is removed from your breast to help find out if there is cancer. Doctors can use imaging procedures to help see the area and remove tissue. Such procedures include ultrasound-guided, needle-localized, or stereotactic biopsy.